Government of Odisha

State Scholarship Portal

Scholarship Application Form For Academic Year 2019-20

Application Number : 3435734 Fresh Application Scheme : Post Matric Scholarship-OBC/SEBC

Personal Details
Name : KAVITA SAHU Gender : Female
FARENDRA SAHU Mother's Name : DIPTIMAYI SAHU
Father's Name :
Annual Income : Rs.40000/- Date of Birth : 07/08/2002
Category : OBC/SEBC Religion : Hindu
Special Category : No ADHAAR Card No. : XXXXXXXX0441
Caste Certificate E-OBC/329 OF 2016 & 10/06/2016 Caste Certficate TAHASILDAR
No. & Date : Issued by :

Academic Details
Institute : ODISHA ADARSHA VIDYALAYA Tehsil / District : Nuapada /Nuapada
NEGIPALI
Course : Plus 2 / Science,First Year Academic Year : 2019-20
Hosteller : No 10th Class Details: C.B.S.E. Board /2019 /6127739
Hostel Admission N.A. Last Exam 27.10
Date: Percentage:
Enrolment No. and 16 & 27/06/2019 Admission date for 27/06/2019
Date : Academic year
(2019-20) :

Contact Details :
Correspondence ward no-16,dumerdihi Permanent ward no-16,dumerdihi
Address post-khariar road, DISTRICT :- Nuapada Address post-khariar road, DISTRICT :-
, STATE :- Odisha , PIN CODE :- Nuapada , STATE :- Odisha , PIN
766104 CODE :- 766104
Contact Numbers : , 8339821252 Email Address : tsahu4049@gmail.com

Bank Details :
SBIN0007078 Branch Name : KHARIAR ROAD, Nuapada
IFSC Code :
Bank Name : STATE BANK OF INDIA Account Number : *******2535
Branch Address: DIST : NAWAPARA, 766014

Declaration
I, KAVITA SAHU S/o / D/o/ W/o/ C/o FARENDRA SAHU hereby declare that the information given in the application form is true as
per my knowledge and belief. I also undertake that if, at any stage, it is found to the satisfaction of the sanctioning authority that the
information given by me is false, the entire amount of scholarship will be recovered from me, apart from such penal action as warranted
by law. Further, I hereby consent that I have no objection in authenticating myself with Aadhaar for the purposes of availing Post-matric
Scholarship.

Check List
Document to be attached : -
a. INCOME CERTIFICATE (IN CASE YOU ARE RENEWING YOUR APPLICATION IN A NEW COURSE)
b. SELF DECLARATION OF CASTE AS GENERAL (IN CASE OF EBC STUDENT)
c. AADHAAR
d. SELF-ATTESTED CERTIFICATES/MARKSHEETS OF ALL EXAMS PASSED
e.FIRST PAGE OF BANK PASS BOOK CONTAINING THE NAME OF ACCOUNT HOLDER, ACCOUNT NUMBER, IFSC CODE.

(Signature)

Generated by Odisha Scholarship Portal as on 08/01/2020